What is Fentanyl?

OPIOID

Fentanyl belongs to the class of drugs called opioids, which are used to reduce pain. This category also includes morphine, oxycodone and heroin. Of these, fentanyl is one of the most potent, and is approved for medical use as a surgical anesthetic or for people with chronic pain (typically terminal cancer patients). Opioids reduce physical and emotional/psychological pain and can have a euphoric effect in high doses, which is why people sometimes misuse opioids.

SYNTHETIC

Unlike morphine and heroin, fentanyl is not derived from the opium poppy. Rather, it is a synthetic product, meaning it is “formed through a chemical process by human agency”; i.e. it is not derived from plants. This means that it can be produced quickly – it is not dependent on agricultural and harvest conditions. Since the supply is only limited by the availability of the precursor chemicals and the availability of people to make it, fentanyl is exceptionally cheap and easy to make compared to plant-based opioids.

POTENT

Fentanyl is good at its job. It is a highly effective and efficient pain reliever. It is 50-100 times stronger than morphine. All the properties are amplified, so it takes a lot less fentanyl to get the same effect as morphine or heroin. That has many of implications, for instance:

• Just a tiny amount can be lethal, especially if you don’t have a

  tolerance to opioids.

• Fentanyl takes effect faster and wears off sooner, making it highly addictive and harder to kick.

Standardized dosing in a pressed tablet requires precise measures of minute quantities, something that is not guaranteed by illegal suppliers. The difference between high and die is often a few milligrams, or roughly a few grains of salt.

In addition to being extremely potent, fentanyl has a very small therapeutic index. This means that the amount of fentanyl it takes to have an effect is almost the same as the amount it takes to kill a person. That is why fentanyl is so carefully dosed and closely monitored in medical settings.

Illicit fentanyl also has a small therapeutic index, but it is manufactured without the necessary quality controls, so the potency of any given batch is an unknown variable. Combine this with improper blending when it is cut into powders and then pressed into pills, and you have a literal recipe for disaster: street drugs made with a potent, sensitive raw material that is unevenly distributed within the end product.

Illicit fentanyl is synthesized by combining and mixing specific raw materials (precursor chemicals) in the proper ratios. The precursors are highly regulated in the U.S. but relatively easy to acquire from makers in China and India since they have other legitimate uses in chemistry and are not as tightly regulated there.

Manufacturing pharmaceutical-grade fentanyl requires the use of special equipment and conditions, but clandestine labs can make much lower quality illicit fentanyl with no special equipment. Making fentanyl is not dependent on climatic conditions, seasons, or weather, which means that fentanyl can be made quickly and in large quantities – anywhere at any time.

Beginning around 2014 China was the primary source of illicit fentanyl powder coming into the U.S. and Mexico, shipped directly through postal and shipping services. Drug traffickers based in the U.S. and Mexico then cut the illicit fentanyl powder into heroin and other drugs or pressed it into counterfeit prescription pills.

In May 2019, under international pressure, the Chinese government banned the production and sale of fentanyl analogs, leading to the significant reduction of the amount of illicit fentanyl being shipped directly from China to the U.S. and Mexico. Since then, Chinese vendors have shifted their manufacturing to precursor chemicals, selling them to the Mexican cartels via online networks.Currently, most of the fentanyl in the U.S. illicit drug market comes across the southern border from Mexico. Mexican Drug Trafficking Organizations (DTOs) manufacture fentanyl using Chinese precursors and smuggle it north in powder or pressed pills.

With pressure being put on the Chinese supply chain, India and Mexico have become emerging sources of fentanyl and precursor chemicals, and the DEA expects the number of countries producing these precursor chemicals to increase. DTOs are likely poised to take a larger more significant role in the production and the supply of fentanyl and fentanyl-containing illicit pills to the United States. We can expect that illicit fentanyl production and precursor chemical sourcing will become increasingly global as time goes on.

(Source: DEA)

In toxicology, the lethal dose for a substance is referred to as the LD50, or median lethal dose, which is the amount that is needed to kill 50% of a sample group. Toxicologists point out that it is impossible to determine a precise LD50 for opioids because tolerance builds in lab subjects as the dose is increased. In other words, the lethal dose for any opioid is a moving target, technically speaking.

The DEA says that 2 milligrams (mg) of dry powder fentanyl is a “potentially lethal dose.” This general statement makes the point that a small amount can be deadly. In fact, the actual amount of fentanyl that will cause death varies depending on the person’s weight, whether they have used opioids before, their metabolism, their general health, and more. The amount of fentanyl that will kill a 110-lb person who has never ingested opioids will be different than the amount that will kill a 220-pound opioid dependent user. Therefore, a “lethal dose” may not cause death to everyone who consumes it. Conversely, a person could die from an amount of fentanyl that is less than the “lethal dose” of 2mg.